The cervical cancer screening program in the North of Portugal: Outcomes after nearly two decades of coexistence with the human papillomavirus vaccine

As the first vaccinated cohorts are gradually becoming eligible for cervical cancer screening (CCS), changes in the distribution of high-risk human papillomavirus (hrHPV) infection and associated disease endpoints are expected to occur. We aimed to describe the clinical outcomes of the Regional CCS Program of the North of Portugal in the latest years and to estimate the impact of different hrHPV genotypes on the occurrence of cervical neoplasia. Secondary data collected from the Regional CCS Program of the North of Portugal between January 2019 and December 2024 was used. Descriptive analysis was performed, and the proportion of high-grade squamous intraepithelial lesion (≥HSIL) attributable to different hrHPV genotypes was estimated. Between January 2022 and December 2024, the prevalence of hrHPV infection was 14.1%, and multiple infections accounted for 28.4% of the cases. Overall, the most prevalent genotypes were HPV-68 (16.6%), HPV-52 (14.5%), and HPV-31 (13.3%). Among the samples that underwent cytological analysis, 14.8% were atypical squamous cells of undetermined significance, 7.2% were low-grade squamous intraepithelial lesion, and 3.9% were ≥HSIL. Between 2019 and 2024, there was a decrease in the prevalence of the hrHPV genotypes included in the quadrivalent vaccine (17.5%-11.4%), especially in the youngest females, who also experienced a decrease in the frequency of ≥HSIL (6.0%-2.4%). The proportion of ≥HSIL attributable to these hrHPV types decreased from 38.5% to 23.5% in the youngest females, and no significant variations were found for the remaining. This study highlights the considerable reduction of the prevalence of both hrHPV infection and associated cervical abnormalities among the youngest and presumably vaccinated cohorts.